Glaucoma
Glaucoma is one of Dr Carmen Oakely’s subspecialties.
To learn more about Glaucoma and how it is treated, hit the links to the right, or alternatively scroll down this page which provides all of this information.
WHAT IS GLAUCOMA?
GLAUCOMA ASSESSMENT
TYPES OF TREATMENT
What is Glaucoma?
Glaucoma is the name given to a group of eye conditions resulting in loss of vision due to damage to the nerve at the back of the eye (the optic nerve).
Most commonly this visual loss is gradual, and starts in the peripheral vision, so is often not noticed by the patient until visual loss is severe and involving the central vision.
Often this occurs in conjunction with elevated pressure in the eye (intraocular pressure or IOP), however, in some cases people develop glaucoma with normal pressure.
There are many potential underlying causes for glaucoma and a thorough history, examination and some additional tests are required to determine the cause in each case.
Underlying causes for glaucoma can be related to:
- abnormalities affecting only the eye
- systemic conditions such as diabetes
- use of some medications such as steroid medications
- prior trauma to the eye can also cause glaucoma
Glaucoma Assessment
When you come to the clinic for your initial assessment, you will have a number of tests done prior to seeing Dr Oakley.
These tests will allow Dr Oakley to determine if you have glaucoma, how severe it is, and which treatment options are suitable for you. These include:
- Visual acuity
- Visual field testing
- OCT scan of the optic nerve and the macular
- Auto refraction
There may be additional tests that are performed on the day, depending on your individual situation. These will be discussed with you on the day.
After the tests are completed, you will see Dr Oakley for a thorough clinical examination of the front and back of the eye.
After the examination you will have an opportunity to ask any questions, and discuss available treatment options for your particular type of glaucoma.
It is likely you will need to have your pupil dilated for your first visit to the clinic, and therefore you will need someone to drive you home afterwards.
For subsequent appointments you should check with reception staff when you make your appointment if you will have dilating drops during the appointment.
Types of Treatment
The most appropriate treatment option for you may depend on the underlying cause of your glaucoma and severity of the disease.
All treatment options will be discussed with you at the time of your initial consultation, and the option that provides the best treatment for your glaucoma, while taking into consideration your lifestyle and other medical problems, will be decided on by you and Dr Oakley.
Once glaucoma has been diagnosed, the condition needs to be managed for the rest of your life. Although treatment may lower the IOP, it is possible for it to increase again with time, and therefore you will need lifelong monitoring to prevent vision loss.
Medical Therapy
Medical therapy consists of eye drops, and in some cases tablets.
Eye drops need to be used daily, or in some cases twice per day, and therapy is usually ongoing for the rest of your life.
There are multiple different types of eye drops used to treat glaucoma.
If you and Dr Oakley decide this is the best option for you, you will work together to find the right eye drop regime for you.
For many patients, their glaucoma can be controlled with just one eye drop a day.
Laser Therapy
There are many laser therapy options available, depending on the type of glaucoma you have.
These are described in this section.
Selective laser trabeculoplasty (SLT)
This is a laser procedure which allows fluid to drain more effectively through the trabecular meshwork (the area where it is supposed to drain out of the eye).
The procedure can be completed in the clinic rooms, and requires only anaesthetic drops. Usually it is performed over two sessions, to reduce the amount of inflammation in the eye.
These sessions may be spaced a week apart. Often, the intraocular pressure is lowered sufficiently to stop one of the IOP lowering medications if you have already started on drops. This can also be used as a first line treatment, instead of using drops, if that is your preference and your type of glaucoma is suitable for treatment via this method.
Laser peripheral iridotomy (PI)
This is a treatment where a tiny, microscopic hole is made in the iris (the coloured part of the eye), to prevent fluid getting trapped behind the iris, causing the IOP to become very high.
This procedure can be performed in the clinic room, with anaesthetic drops. Typically, you will require anti-inflammatory drops for 1 week after the procedure.
This procedure is indicated for patients who are at risk of having an episode of angle closure, due to the anatomical structure of their eye. Following your examination, Dr Oakley will be able to advise you if this applies to you.
Cyclodiode
This is a laser procedure which works to decrease the amount of fluid produced by the eye, and therefore lower the IOP. It is done in the procedure room in the clinic or in theatre, and requires a short acting local anaesthetic block.
Typically, it will take 4 weeks to take effect, so any glaucoma medications you have been using will need to be continued during this time.
Surgical Therapy
There are many different surgical options available for glaucoma. The best option for you will depend on many factors, including the type of glaucoma, severity and other medical problems. With all glaucoma procedures, you should not drive until you have been given the all clear for driving from Dr Oakley.
Your vision may take a few days or weeks to return to baseline after glaucoma surgery, and in some instances, you may need to update your glasses when the healing has finished in order to optimise your vision.
Despite having surgery for your glaucoma, you will still need to have ongoing monitoring, and may need to have additional treatments in the future to control your glaucoma and prevent vision loss.
This includes:
- Minimally invasive glaucoma surgery
- Minimally invasive bleb surgery
- Trabeculectomy
- Glaucoma Tube Surgery
Minimally Invasive Glaucoma Surgery
There are a number of surgical procedures which fall under the umbrella term ‘minimally invasive glaucoma surgery’ or MIGS. These procedures are typically stents inserted at the time of cataract surgery, to address both cataract and glaucoma. There are a number of different devices available, and Dr Oakley will discuss the best option for you during your consultation.
MIGS is done in conjunction with cataract surgery. A small stent is placed in the drainage angle prior to the cataract being removed. It takes an additional 10 minutes on top of a standard cataract procedure, and there is no increased risk of complications. This procedure is usually performed with local anaesthetic and sedation. Visual recovery is very quick, with improvement in vision in the first 24-72 hours.
The follow-up is the same as for a routine cataract patient in the postoperative period. You will be reviewed the following day, week 1 and then 4-6 weeks after the procedure. You will require lifelong follow up and monitoring for your glaucoma. If you were on drops for glaucoma prior to the procedure, you may be able to stop your glaucoma medications afterward, but this will be reviewed at your week 1 appointment. You will need routine postoperative drops including anti-inflammatories and antibiotics for your cataract procedure.
Minimally Invasive Bleb Surgery
The preserflo is a modern device, offering minimally invasive glaucoma surgery for patients with moderate to severe glaucoma which is getting worse. Similar to a traditional trabeculectomy in many ways, however, due to some design features of the preserflo, the device allows the procedure to be carried out with a smaller incision, allowing for faster recovery.
The procedure takes approximately 20 minutes in total. A small implant is inserted into the eye during the procedure, to allow fluid to drain from the eye and lower the IOP. The procedure can be completed under local anaesthetic with sedation and you can go home the same day. At the end of the procedure there is a small stitch, which is removed at the two week follow up.
Follow up will be at day one then weekly for the first 2 weeks, before stretching fortnightly. You will need to use antibiotic drops for at least 1 week and anti-inflammatory drops for 12 weeks after the procedure. It is likely you will be able to stop your glaucoma medications after having this procedure, however, this will be reviewed during the postoperative period.
Trabeculectomy
This is a traditional glaucoma procedure, where an incision is made in the white of the eye (sclera) to create a trap door, forming a new drainage pathway for fluid to exit the eye. This is typically performed when your glaucoma is not responding to other treatment options.
The procedure takes approximately 30 minutes to complete. Usually it is performed under local anaesthetic with sedation and you can go home the same day. There are stitches in the eye at the end of the procedure. These are typically removed at 1-2 weeks, depending on healing.
You will be seen in clinic the following day, and then weekly for 2 weeks. Your follow up after this will depend on your individual circumstance. You will need to use antibiotic drops for at least 1 week after the operation, and anti-inflammatory drops for 12 weeks. It is likely you will be able to stop your glaucoma medications, however, this will be reviewed by Dr Oakley.
